OBJECTIVE: This study aims to identify the underlying causes of deaths among elderly people.METHODS: Prospective cohort study with a mean follow-up time of 9.4 years. From July 1997 to April 2007, 840 older people (564 women, 276 men) seen at ambulatory services have been studied. The underlying causes of deaths were classified according to the ICD-10, being identified through direct observation of the occurrence of the death, by the registrations of health services and through information of the families. The individuals were stratified according to age group (60 to 79, 80 years or more) for analysis of the causes of mortality.RESULTS: During the time of follow-up, 203 (36.0%) deaths were identified, with a larger proportion among the men (42.8%) (p = 0.005). The main causes of death were diseases of the circulatory system (42.2%), malignant neoplasms (17.1%) and diseases of the respiratory system (15.4%). Older people aged 80 years or more had a higher risk of death than those aged 60 to 79 years (74.2% vs 25.7%) and a higher frequency of deaths due to neurological diseases (p = 0.02) and due to external causes (p = 0.05).CONCLUSIONS: Results show that mortality due to cardiovascular diseases prevails in this group of older people and that there is a larger proportion of deaths due to neurological diseases and external causes among those with 80 years or more of age. These conclusions can contribute to the establishment of strategies that promote health status in geriatric populations.

OBJECTIVE: To verify the occurrence of alteration of intestinal habit between elderly that they consume milk.METHODS: Transversal study with collection of secondary data. Elderly of both the taken care of sex of February 2004 the December of 2006, in an ambulatory unit of an urban center. The data had been collected in the fiche of first consultation of nutrition, referring to the partner-demographic and dietary conditions. The milk consumption was measured by the 24 hours recall method. Alteration of intestinal habit was considered the self-reported of diarrhea and flatulence after milk intake. The analysis statistics of the joined results was made by means of the use of test T of two samples. The level of significance were fixed in 5% (p < 0,05).RESULTS: Were studied 274 elderly, 75,5% female and 24,5% male. Milk was consumed by 93,1 % of the sample. Of these, 12,6% had presented alteration of the intestinal habit. The average milk intake was of 256,4 mL. The average intake of that they consumed milk and they had presented alteration of intestinal habit the 250,2 mL (DP +/- 158,9 ml). Already the ones that had not presented alteration in the habit, the average intake was of 277,5 mL (DP +/- 183,8 mL). These differences had not been presented statistically significant. Conclusion: Low independent milk consumption of the alteration of the intestinal habit occurred and this was present in 12,6% of the sample that consumed milk. It didn't have statistically significant association between the milk consumption between the elderly ones that they had presented intestinal alteration and the ones that had not presented.

OBJECTIVE: To assess the validity of the geriatric depression scale (GDS) (4-item short form - GDS-4) to screen for depression in elderly primary care patients in Brazil.METHODS: Cross-sectional study among 220 patients aged 60 or over attending 4 primary care clinics in Fortaleza city, Brazil. Those unable to answer the questionnaire because of impairments in communication skills were excluded. All included patients after completing the GDS form were submitted to the structured clinical interview for the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) which was used as gold-standard to establish the diagnosis of major depressive disorder. The outcomes were sensitivity; specificity; positive (PPV) and negative (NPV) predictive values; accuracy and likelihood ratio (LR) of a short version of the GDS (GDS-4).RESULTS: The sensitivity, specificity, PPV, NPV and LR of the GDS-30 were respectivelly 84,2% (68,1 - 93,4 = 95% CI), 74,7% (67,7 - 80,7 = 95% CI), 41% (30,2 - 52,7% = 95% CI) e 95,8% (90,6 - 98,3 = 95% CI). The accuracy and LR were respectivelly 3,9% and 76,3%.CONCLUSIONS: GDS is a useful tool in helping clinicians to screen for major depression in older primary care patients. The 4-item short-form (GDS-4) may be an alternative and more practicable screening tool to be routinelly used in primary care.

The population of developing countries is ageing rapidly, bringing new challenges for public health. In developing countries, the growth of the aged population occurs in environment of poverty and great social inequality. In such environment, risk exposures and diseases are more frequent and, on the other hand, the resources for treatment and rehabilitation are scarce. The epidemiology plays a central role for public health. Epidemiologic studies provide scientific evidences that are essential for subsidizing polices toward the elderly health. In this paper, some types of epidemiological studies are described (ecological, cross-sectional, case-control and cohort studies), as well as some of their uses. Among the uses of epidemiology, the following were considered: (a) surveillance; (b) health survey; (c) validity and reliability of diagnostic tests; (d) natural history of diseases; (e) causes of diseases; (f) evaluation of effectiveness. We used data from a long term Brazilian cohort study of older adults (the Bambui study), as well as data from public hospitalizations in Brazil as examples. The results of these studies are examples of the usefulness of the epidemiology to investigate the distribution of health-related conditions in the aged population, as well as their determinants.

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